Unnecessary antibiotic use for mild acute respiratory infections during 28-day follow-up of 823 children under five in rural Vietnam

Abstract

Few prospective studies regarding antibiotic use for mild acute respiratory infections (ARI) have been conducted in community settings. This paper aimed to assess knowledge of children's caregivers and actual antibiotic use for children under five and to identify factors associated with antibiotic treatment for mild ARIs. Caregivers in 828 households in Bavi, Vietnam, were interviewed using a structured questionnaire assessing both knowledge and practice. Subsequently, 823 children were followed for 28 days to collect information regarding symptoms and drug use. For management of ARIs, only 13% of caregivers demonstrated correct overall knowledge in accordance with standard guidelines. The symptoms of the most recent illness were consistent with mild ARI in 79% of cases, and antibiotics were used in 71% of these. During the 28-day period, 62% of children had been given antibiotics and 63% of antibiotic courses were used for mild ARIs. One-half of the mild ARI episodes and 63% of the children with mild ARIs were treated with antibiotics. Most of the unnecessary antibiotic treatment was recommended by healthcare providers (82%). Most of the children had been administered antibiotics for common colds, although most caregivers believed that antibiotics were not required. Antibiotics were unnecessarily recommended at health facilities in the area.

Antibiotic use and resistance in emerging economies: a situation analysis for Viet Nam

“…Despite this, antibiotics continue to be dispensed without a doctor’s prescription [13]. In 2007, the circular on Good Pharmacy Practice (GPP) was issued to improve the standard of pharmacy [14].…”

“…From 1999 to 2007 Streptococcus pneumoniae penicillin-resistance rates increased from 8% to 75% in Ba Vi [25]. In 2007, the pattern of antibiotic use changed, as oral cephalosporins became commonly used for ARI, with similarly high proportions of patients receiving antibiotics [13]. …”

“…Reasons for irrational antibiotic prescribing are the same as in other countries: perceived patient expectation; time constraints; lack of knowledge; lack of diagnostics; pressure, incentives and advertising from industry; and financial benefits for the prescriber [13]. High out-of-pocket costs of formal healthcare mean that direct purchase of drugs is more affordable for patients.…”

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“…Data from 88 human isolates from 1996 to 1999 indicate that 7% of isolates were resistance to nalidixic acid and ciprofloxacin and all strains were sensitive to azithromycin [41]. A likely explanation for this is the increased use of antimicrobials in human and veterinary medicine over the same period [42, 43]. …”

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“…This result does not agree with a study done in rural Vietnam which found that most of the children had been administered antibiotics for common colds, although most medical staff believed that antibiotics were not needed. Antibiotics were abused at health facilities in the area 11 and another study done in Taiwan which imply the need for programs to maintain greater education about antibiotics use in the general public of Taiwan 12 .…”